APPLICANT'S ABSTRACT: The fundamental goal of this line of research is to find ways to manage the treatment of patients with alcohol problems that produce the best possible long-term outcomes at the lowest possible cost to society. Clinical strategies that produce short-term effects on drinking outcome measures may or may not have substantial long-term impact on health care or other costs which are of substantial social interest. We are building upon existing research on the impact of a program of follow-up monitoring and referral on the clinical outcome and long-term health care use of alcohol patients. Ours is the first modern study in which a deliberate effort has been made to maximize "cost offsets" from alcohol treatment. We are extending our earlier research done in day hospital settings to detoxification settings. Patients will be randomized into a modified and intensified case monitoring intervention vs. standard treatment. This monitoring program is designed to augment the effectiveness of existing addictions treatment services, not to replace them. The intervention will help ensure that patients stay in contact with the health care system over a clinical follow-up period of 1.5 years. The intervention can be delivered at a low cost per patient per year. The rationale for the intervention design is based not only on our own prior research but also protocols used successfully in other mental health fields, prior research in addictions, the literature on social support, and models for relapse. This proactive system for maintaining contact with patients is intended to remedy a defect in the present system of delivering treatment to alcohol abusers. Now, many patients entering detoxification who could benefit from further treatment fail to seek services until their situation has once again deteriorated substantially. A proactive, continuing connection to treatment services, and earlier re-entry into treatment should improve average outcome levels and over the long run reduce health care costs by minimizing the need for high levels of care to deal with severe crises. Data from prior funding indicate that the intervention has positive effects. New funding will make it possible to determine whether these effects can be generalized to detoxification settings, allow us to test further hypotheses about the mechanisms of action of the intervention, allow us to implement and test improvements in the protocol, and allow us to determine more accurately the nature, time course, and factors associated with changes in health costs after alcohol treatment.